Department of Pathology, Hospital de Oncologia, Instituto Mexicano del Seguro, Mexico, D.F., México.
Arch Med Res. 2010 Aug;41(6):436-41. doi: 10.1016/j.arcmed.2010.08.010.
In its most florid form, classic lobular intraepithelial neoplasia (LIN) proliferates to form a solid mass of tumor cells that fill and expand the duct within the terminal duct lobular unit lumen. Foci such as these can develop central necrosis and calcifications, detectable on mammograms. The immunohistochemical expression of E-cadherin has been found to be absent in all reported examples of LIN with necrosis. The occurrence of LIN composed entirely of signet ring cells with central necrosis is extraordinarily rare.
We described 10 of these cases to illustrate this uncommon morphologic pattern of LIN. The cases were encountered during routine clinical practice of the authors over a 5-year period at the Oncology Hospital of the Mexican Social Security Institute in Mexico City. Cases were comprised of several (>6) foci of LIN with signet ring cells as well as with comedo-type necrosis.
Age of patients ranged from 45-75 years (mean age: 51.2 years). The indications for biopsy were calcifications (n = 7) and mass (n = 3) on mammograms. Luminal necrosis was seen in all ten cases and calcifications in seven cases. Eight cases had associated invasive carcinoma, including six lobular carcinomas and one composite carcinoma (lobular and ductal). All cases showed a lack of E-cadherin membrane staining and a diffuse cytoplasmic immunoreactivity for high molecular weight keratin, positivity for estrogen receptors and progesterone receptors was present in 9/10 and 8/10 of cases, respectively.
LIN composed entirely of signet ring cells can develop macro-acini, central necrosis and calcifications. These cases are frequently associated with invasive lobular carcinoma at the time of initial presentation.
在最典型的小叶上皮内肿瘤（LIN）中，肿瘤细胞呈实性增生，充满并扩张终末小叶单位管腔。这种肿瘤会出现中央坏死和钙化，在乳房 X 线摄影中可被发现。在所有报道的伴有坏死的 LIN 病例中，E-钙黏蛋白的免疫组化表达均缺失。而完全由印戒细胞组成并伴有中央坏死的 LIN 极为罕见。
我们描述了 10 例这样的病例，以阐明这种罕见的 LIN 形态模式。这些病例是作者在墨西哥城墨西哥社会保障研究所肿瘤医院的日常临床实践中遇到的，在 5 年的时间里共发现了 10 例。这些病例由多个（>6 个）LIN 病灶组成，包括印戒细胞和粉刺样坏死。
患者年龄 45-75 岁（平均年龄：51.2 岁）。活检指征为乳房 X 线摄影显示钙化（n=7）和肿块（n=3）。10 例均可见管腔坏死，7 例可见钙化。8 例有浸润性癌相关，包括 6 例小叶癌和 1 例复合癌（小叶癌和导管癌）。所有病例均缺乏 E-钙黏蛋白膜染色，高分子量角蛋白弥漫细胞质免疫反应阳性，雌激素受体和孕激素受体阳性率分别为 9/10 和 8/10。
完全由印戒细胞组成的 LIN 可形成大腺腔、中央坏死和钙化。这些病例在初次就诊时常常伴有浸润性小叶癌。
